Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214998 DEA: 044H0504 EFIS: 0413000080
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-12-25.8-33.3
Work Description: BRIDGE SCOUR MITIGATION
Location Description: SONOMA COUNTY NEAR SANTA ROSA AT SONOMA CREEK BRIDGE AND AT HOOKER CREEK BRIDGE
Contractor Name: Ghilotti Construction Co. (Nishit Prajapati)
Contractor Address: 246 Ghilloti Ave, Santa Rosa CA 95407
Resident Engineer: leonard brajnikoff Structure Rep.: Anthony tierra
DIME Sample ID: 2023-08-21-31
TL Number from the TL Form:
Sample Submitted By Organization: Ghilotti Construction Company
Sample Organization Contact: (669) 600-1564
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/21/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/22/2023
The quantity of what the sample constitutes: 18 CY
A brief description of the sample: a total of 6 cylinders of 4x8 size
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 20-0305
Structure name: 20-0305 Sonoma Bridge
The fabricator/manufacturer/facility name: Shamrock Materials Inc
The concrete mix design number: D67112P1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 138
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: On the hopper
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-08-21-31-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 01/03/2024
Date Tested: 08/21/2023
Submitted By Organization: Ghilotti Construction Company
Organization Address: 246 Ghilotti Avenue,
Organization City: Santa Rosa
Organization State: CA
Organization Zipcode: 95407
Organization Email: nishitp@ghilotti.com
Organization Phone: (669) 600-1564
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2023-08-21-31-2
Test Method: ASTM C143-10a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: Ghilotti Construction Company
Organization Address: 246 Ghilotti Avenue,
Organization City: Santa Rosa
Organization State: CA
Organization Zipcode: 95407
Organization Email: nishitp@ghilotti.com
Organization Phone: (669) 600-1564
Data has not been verified.
